According to the office of national statistics around 70% of the UK suffers with back pain. Why is this? What can we do about it?
Some people may think that they have lower back pain simply because they are genetically susceptible to it, or maybe they picked something up from the ground wrong once and now they will always suffer with lower back pain. It can feel like there is no solution for back pain, but trust me there is. No its is not solved with medication which most of us turn to. Prevention is miles better than cure.
The truth is, for a majority of people lower back pain is a result of our environment. This is the position that we put ourselves in, or the position we need to be in for the majority of the day. I am talking about those of us who are desk bound, seat bound or even stood still for the majority of the day. It is very common for people to drive to work in the mornings sit at their desk all day, come home sit down to eat dinner and then sit down to watch TV for the rest of the evening. This results in a huge amount of the population being very sedentary and developing all kinds of problems and pains. The most common of these is lower back pain. This is something I feel quite strongly about because it is so avoidable for most people, particularly desk workers. After being in the Army as an analyst for 8years I found myself desk bound for the majority of the day doing exactly the same thing as most desk workers. My pain was compounded however by occasionally having to wear a heavy backpack and march long distances, which has its own pressures on posture.
When you look into this it is so very obvious our environment is the main contributor to our mobility issues, we are not born with them. If you look at a young child pick something off from the floor they perform a perfect squat with weight over the midline of their foot and a perfectly straight back! All of the muscles fire perfectly without and there are not mobility issues whatsoever. The squat is a natural movement pattern which all young children possess, no one has ever taught them how to do this. So why do most of us struggle to get into a squat? Chairs.
Chairs and sitting down is a relatively modern and western invention, one which our bodies are not designed for. Take a look at the skin on your feet, it is much tougher than the skin on your butt, I hope so anyway. That is because our feet are deigned for weight bearing, our butt is not.
If you ever visit a 3rd world country or Asian country, you will notice that people very rarely sit down. They squat, with perfect form, for as long as you or I would sit for They also go to the toilet in this position, which is also much a much healthier and a more natural position for the body.
When I was away with the military I spent 6 months with Afghan police, any time we held meetings with them they would squat down for the whole meeting, or sit crosslegged, this was difficult for us and the police would find it funny that we were not able to sit or squat comfortably with them. We also only had 'squatting toilets', so for the first time in my life I had squat to go to the toilet. This is difficult for the first few attempts, well more like the first few months. But eventually you get used to it and actually I found it difficult to 'go' once I got back to going on a 'normal' toilet. My body had got used going in the squatting position and it was actually uncomfortable for me to go to the toilet on a normal throne!
Despite all of us being born with a perfect squat and no back pain, at the age of around 6, maybe ever before that we are forced to sit in chairs and learn things. Sitting for around 4-5 hours a day in a chair limits the range of motion in our hips. Sitting in chairs causes flexion at the hip and shortens the hip flexor, we end up staying in this position for the majority of the day, we eat in this position and in the evenings we sit to do our homework or watch TV. So inevitably the hipflexors get used to being shortened and become tight..
The other thing that happens when we sit down to long is that out butt shuts off. Our butt, or to give it is proper name, our gluteus-maximus and other posterior chain muscles become lazy. The posterior muscles relax, so even when we do movements which require their inputs (deadlifts, squats, olympic weightlifting) we are unable to recruit them because our body has become 'retarded' and does not know how to use them. Instead we use our anterior muscles (i.e the muscles on the front of our body). If you squat using only the anterior muscles, you will shift your weight forward onto your toes and your heels will lift off the floor. Doing this particularly with weight on your back puts pressure on joints in a direction they are not designed for. For me and many others it is the knees which start to hurt, we therefore conclude that squatting is bad for he knees, so we stop squatting. In actual fact squatting is great for improving the muscliacture around the knee and can make it a much more stable and strong. Since learning how to recruit the right muscles and squat properly I now have no knee pain at all ever, which is nice considering a few years ago, there would be occasions where i was limping from knee pain.
So as you may have noticed, I am not a fan sitting down, if you have a desk job as I did, then investigate getting your hands on a stand up desk. If you are in the military then you can get one through the medical system now, I would have done this if I had stayed in. If you are in a normal office setting I genuinely believe that with a bit of research you would be able to argue a health and safely risk of sitting down all day! There are also reported improvements in productivity of people who stand up for work. You do not have to spend a fortune, getting a few boxes to prop up your screen and keyboard would be sufficient (though it might not be very visually appealing). I made my own standup desk when away with the military and stood up all day every day, which was great. Today I have invested in a actual adjustable desk which I can raise and lower as I please. The difference in my own back pain is massively reduced and my postierior chain works a lot more effectively.
Now before you run out and buy a stand up desk and stand around all day, remember that standing still all day vs sitting all day are just as bad. You still need to move around regularly, you might find that a bar stool or an adjustable desk would be a good way to start out as standing up 100% of the time straight off can be painful. You also need to be doing mobility and muscle engagement to fix the years you hvae spent in a chair position. If you have been hunched over a desk typing for a long time then you might also find you have tight shoulders. If you are a driver then you absolutely want to be doing there exercise to combat the time you spend sitting down, I would even consider changing career if your back pain is that bad! But obviously that is not always an easy option.
The following are some key exercises for countering back pain, I use this as my warmup before I do pretty much any exercise. It is key that you take your time to warm up and engage the muscles you are about to use, particularly if you have been sitting down all day. You can also do this anywhere if your back pain is bad and you want to relive it.
When you roll create a brace by placing your hands on your head and rounding forward slightly, keep your core engaged. Place your foam roller in the middle of your shoulder blades and roll down towards your lower back. Work your way around your back up and down, even a bit of side to side. This will mobilise the upper spine, which if you have been seat or desk bound for long periods of time then you will find can get pretty stiff! There is no need to go higher up than about the shoulder blades.
Go onto all fours and look upward and press your belly towards the floor arching your back. Hold for a second and do the opposite rounding your back and tucking your head under. This will also mobilise the muscles in the upper back and get the synovial fluid warmed up around the spine, that is the lubricating fluid which surrounds most joints in the body. Do this slowly and under control for 6 reps, breath out as you press your belly to the floor and in as you arch upwards.
Start in the kneeling position and sit back onto your heels, stretch your arms out in front of you and reach forward, keep your butt on your heels if possible. If you have ever done yoga this is similar to childs pose. If you want a more intense stretch then you can rotate your hands outward, or elevate your hands onto a bench or foam roller.
The main focus is the hip flexor here, so if your short on time go for the hip flexor first, but otherwise you can play around on your whole quad here, roll onto the ITB which runs down the side of your leg as well. To find the hip flexor place your foam roller on your hip bone and roll down slightly, about an inch should be far enough. Roll side to side rather than up and down, until you come across a tender spot, once you have the tender spot then hold it for about 6seconds. The key here is to try and relax, if you are not relaxed, then you will not be able to find the hip-flexor or make any progress in rolling it out.
Now you have rolled out the hipflexors, stretch them out. Go into a lunge, keep your rear foot pointed (if you can without cramping) and place the bottom knee on the ground. Your front knee should be bent 90degrees and directly over your front foot, this is to avoid any knee pain . From here focus on tipping your hips backward. If you want more stretch then squeeze your bum as hard as possible. When you think you have squeezed it as hard as you can, squeeze it again. If you want to get even more out of this, press the rear foot into the ground. Try not to over extend your body or excessively bend your lower back, keep your core engaged throughout. If you are doing all of this and are still not feeling anything then try leaning backwarrds slightly. This is an instense strech for most people if done properly. This is one of the most effective stretches so stay focused on this stretch, keep your form tight througout any pain and hold for at least 30seconds each side.
Go into a long lunge position, place both hands next to the front foot. Take the middle hand and reach skyward into a T shape, hold and feel the stretch in the upper back and hip. For the second part of the movement twist and reach underneath your armpit as far as possible. Do 6 reps here and switch your feet around to stretch the opposite side. This should get you pretty warm.
Lay on your back with your arms out the sides so you are in a T shape. Bend your knees but keep for feet on the floor. Drop your knees to one side and look in the opposite direction. You should feel this in the pectorals (chest) and across the whole front and side of the body. If you cant feel anything then make sure that your shoulder stays on the ground.
Hold a plank position and tap each shoulder for 6 reps, so 12 in total. Focus on keeping your core engaged and try not to wiggle about. If you find your wiggling all over the place put your feet wider. Come down onto your knees if you cannot hold the full plank. This is a core engagement exercise.
Go into a plank position and keep your arms straight, move your shoulder blades together and out again for 6 reps, this will wake up the muscles in your upper back which are used to being rounded and relaxed.
This is a great exercise for waking up your glute muscles (butt). Lay on your back bend your knees so your feet are as close to your bum as possible. Point your toes skyward, but keep your heels on the ground, this will encourage posterior muscle engagement rather than pressing through your toes and using your anterior muscles. Push your hips as high as possible. If this is enough for you then do 12 reps of this. Raise and lower under control, count your self 3 seconds up and down if necessary. Once you have nailed both feet it is time to try this with one foot raised. Keep your knees in line, if you raise your knee to high then you will find this easy. Also try to keep your hips level throughout the exercise. 6 reps on each side should be enough, you will know when they are engaged because your glutes will start to burn!
Tight calfs can be another contributing factor to lowerback pain and cause other injuries, if you are interested in squating or olympic powerlifting then tight calfs can limit your range of motion, particularly in your ankles and hips. Make sure your calfs are not neglected! The same principle is applied here as foam rolling the hip flexors. Once you find a tight spot then hold it and relax, spend as long as you need on your calves but make sure your there for at least 30seconds, it will be worth it I promise. If you find it difficult to get enough pressure on the roller then you can cross your legs over so you have more weight. Or try the 'bone saw', go into a kneeling position and place your shin bone ontop of your opposite calf. You can use your shin as you would use the foam roller and you can sit back on your shin to create more pressure. It painful but works well.
Reach down touch the ground in front of your toes and walk your hands forward until you cant reach any further, then walk your feet in to meet your hands. Once you have rolled out your calf you need to stretch it out, 6 reps up and down doing the inchworm will be plenty. Work into the calves and a bit of hamstring, but main focus is on the calves.
Find a wall and stand facing it. Place your foot as far away from the wall as possible where you can still reach it (just) with your knee. Give your self 6 reps on each side with a 2second pause. make sure you keep your heel on the ground and hips level. You can use the distance between your toe and the wall as a measure of your ankle/calf mobility.
Take a long step out in front of you and lunge forward. Keep the movement controlled and try to push back through the heel using the posterior muscles. Avoid pressing through the toe. You might also get a bonus stretch int he hip flexor as you do this. keep your core engaged throughout.
Same principle as the front lunge, you might not get full depth for the first few side lunges so work your way down as fat as you can go. Play around in the hips making sure you work about any tight spots. Keep the weight towards the heels and try not to press through the toes.
You might notice that there is no focus on stretching the hamstrings, this is because most of us already over stretch them. If you can imagine that our hip-flexors are attached to the front of our hip and our hamstrings are attached to the rear. When the hipflexors are tight, they pull on the front of our hips which then round forward, this is known as anterior pelvic tilt. Anterior pelvic tilt makes the hamstrings feel tighter, so many people stretch them, which lengthen them. This releaviates some back pain temporarily but fails to address the underlying cause. Actually lengthing hip flexors is not something you want, in fact you want to be enaging them so they working properly. This will improve the way you move for all activity which involves the legs.
Follow this routine for a decent warm up and let me know how you get on add in anything else which you feel requires extra attention. I have read in various places that foam rolling and stretching before exercise is not recommend, however I have never found this to be a problem for me. Since following this warmup/movement preparation I have had far less injuries! This is much better than 2mins on a rower to warm up for strength training. If you are desk bound or seat down for the majority of the day then think about how you can improve your position, either by getting a stand up desk, adjusting your screen position. Take a break, stand up and walk about at least once every 30-40mins. There is monumental evidence out there to tell you all about the health benefits of not being sedentary for long periods of time.
If you have any other postural problems which have not bee covered here (there are many) then let me know and I will try and help you out!